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Fresno

    Utilization Management Manager - Fresno, United States - Medasource

    Medasource
    Medasource Fresno, United States

    3 weeks ago

    Default job background
    Description

    Job Title:
    Utilization Management Manager

    Location:
    Fresno, California (travel reimbursement if needed)

    Start Date:

    ASAP
    Duration:

    6-month contract or contract-to-hire


    Summary:


    Our premiere healthcare client is looking to bring in a Utilization Management Director to help with assigned departments and functions across the area continuum of care to provide integrated services in a fiscally responsible manner through direction, support, and development of administrative staff, and community groups and agencies.

    In addition, individual will be responsible for providing development and delivery of a Case Management system that utilizes best practices in the areas of pre-admission, registration, utilization management, discharge planning, case management, and social services.

    The position also ensures that patients receive timely and appropriate care during their hospitalization, for identifying delays in treatment, and for targeting opportunities to improve or enhance resource utilization.

    Additionally, the position is accountable for ensuring timely discharge through early intervention and identification of post hospital care needs, as well as ensuring continuity of care needs are met.


    Essential Functions:

    Knowledge/Skills:
    Knowledge of requirements and eligibility parameters for payers, MediCal, and Medicare
    Knowledge of IPA's
    Knowledge of Epic EMR system
    Knowledge of third party payer billing and managed care requirements
    Knowledge of the Joint Commision and Public Health licensing requirements
    Leadership skills consistent with the mission, vision, and values of the Health System
    General knowledge of illnesses, current treatments, and their physical and psychosocial sequelae
    Knowledge of applicable laws and regulations, government, and insurance benefits
    Knowledge of utilization review process, discharge planning process, use of best practice guidelines and pathways
    Knowledge of statistical data collection techniques and methods of analyzing and reporting statistical data
    Demonstrated leadership skills, including facilitating teamwork, coaching, consensus-building and problem-solving
    Strong foundation of clinical assessment skills necessary to provide care management for clients with highly complex medical, emotional, and social needs

    Improve Performance:
    Strengthens focus on excellence in a culture that measures quality and continues improvement of performance to meet the needs and expectation of patients and community
    Assures that organizational and department policies and procedures are current, appropriate, and followed consistently
    Assures a safe and efficient work environment for employees, assures quality improvement processes are effectively monitoring quality of services and lead to strategies for further improvement
    Creates excellence in how customers are served both internally and externally with staff, works proactively to resolve complex problems in a timely manner
    Follows the performance improvement process, including regular dialogue and feedback with employees about goals, responsibilities, expectations, and performance
    Facilitates implementation of new technology, products, and supplies to provide safe, effective services and maximize productivity
    Models and encourages a spirit of service in the organization (i.e. coordination and delivery of patient care that responds to patient and family needs, physical, physiological, spiritual, and social needs; interdisciplinary QI activities, participation in committees and PI teams)
    Understands and helps others integrate the mission, vision, and values to the strategic goals and operations.

    Communication:
    Has been in previous leadership position and can effectively mentor counterparts
    Clearly communicates the strategic initiatives and direction of the Health system, the region, the area, and the ministry
    Acts as a liaison by effectively involving Medical staff, other departments, and stakeholders
    Maintains accessibility for 1:1 communication with staff and provides avenues for appropriate follow up with employees
    Utilizes team building strategies to promote positive relationships for a cohesive tea
    Openly discusses issues and supports difficult decisions
    Fiscal Stewardship
    Assumes responsibility and accountability for fiscal management of assigned departments across all entities in collaboration with staff and physicians
    Formulates, presents, and defends annual budget (including personnel, supplies, resources, and space) based on assessments of departments resources, programs, and projected needs
    Analyzes trends and identifies opportunities to improve efficiency and productivity and decrease costs
    Implements changes in systems, equipment, and technology to increase efficiency and productivity and to promote cost containment
    Competency
    Holds self and staff accountable for excellence in performance
    Assures timely assessment of employee performance
    Identifies and assures resolution of discrepancies between performance standards through coaching, feedback, and use of the progressive disciplinary process
    Establishes processes to listen and respond to employees concerns, grievances, and suggestions
    Planning
    Initiatives strategic, operational, and programmatic plans/policies to achieve mission and area by vision by providing efficient and effective services
    Encourages ideas, suggestions, and participation of others and involves others in planning, decision-making, and assessment processes
    Performs periodic follow-up to assure actual implementation of changes and their effect on the organization
    Identifies and fulfills educational and developmental needs and keeps updated on advances related to responsibilities

    Requirements:
    Bachelors Degree in Nursing
    Masters Degree in Nursing - preferred
    California RN license

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